The Illegitimacy Of The Psychiatric Bible

The Illegitimacy of the “Psychiatric Bible”
Thomas S. Szasz
The Freeman, November 24, 2010

“Mental health experts ask: Will anyone be normal?” So read the title of a July 27 Reuters report.
The “experts” warned that the fifth version of the Diagnostic and Statistical Manual of Mental
Disorders (DSM), scheduled for publication in 2013, “could mean that soon no-one will be classed
as normal....[MJany people previously seen as perfectly healthy could in future be told they are
ill.”

This is not news. More than 200 hundred years ago Johann Wolfgang von Goethe (1749-1832)
warned: “I believe that in the end humanitarianism will triumph, but I fear that, at the same time,
the world will become a big hospital, each person acting as the other’s humane nurse.”

Moreover, Goethe foresaw the moral hollowness of the “humanitarian science” on which such
therapeutic tyranny would rest: “I could never have known so well how paltry men are, and how
little they care for really high aims, if] had not tested them by my scientific researches. Thus I saw
that most men only care for science so far as they get a living by it, and that they worship even
error when it affords them a subsistence.”

The depths to which such men would happily sink when worshiping error brings them fame
and fortune became obvious only in the twentieth century.

Joaquim Maria Machado de Assis (1839-1908), the great Brazilian novelist and playwright,
advanced the prescient literary satirization of the dark art of psychiatric diagnosis and the engine
that drives it: the phony expert’s insatiable vanity and thirst for controlling his fellow man. His
short story “O alienista” (1882, “The psychiatrist”) is a fable of a celebrated doctor retiring to a
small town to pursue his scientific investigation of the human mind, gradually finding more and
more of the townsfolk insane and needing to be incarcerated in his private asylum. Eventually he
alone is left at liberty. As soon as modern psychiatry became a legitimate branch of medicine,
Machado de Assis recognized and exposed its quintessentially unscientific-sadistic character.

It remained for the French playwright Jules Romains (1885-1972) to call public attention to
the corruption of modern medicine by political power. “It’s a matter of principle with me,” declares
his protagonist, “Dr. Knock” (1923), “to regard the entire population as our patients. .. . ‘Health’ isa
word we could just as well erase from our vocabularies. ... If you think it over, you'll be struck by
its relation to the admirable concept of the nation in arms, a concept from which our modern
states derive their strength.”

Sigmund Freud (1856-1939), too, has played an important part in persuading people that
health is an abnormal state. This old joke is illustrative: “If the patient is early for his appointment,
he is anxious; if he is on time, he is obsessive-compulsive; if he is late, he is hostile.”

Particular psychiatric diagnoses have not escaped professional criticism. Wishing to make a
name for themselves as psychiatrists, “critics” object to one or another diagnosis (homosexuality)
—or to “overdiagnosis” (ADHD)—but continue to respect the American Psychiatric Association
(APA) as a scientific organization and regard the various incarnations of the DSM as respectable
legitimating documents. This is dishonest. Confronted with the DSM, the challenge we face is to
delegitimize the authenticators, the APA and DSM, not distract attention from their fundamental
phoniness by ridiculing one or another “diagnosis” and trying to remove it from the magical list.

I have consistently rejected this piecemeal approach. In my essay “The Myth of Mental Illness,”
published in 1960, and in my book with the same title that appeared a year later, I stated my view

forthrightly. I proposed that we view the phenomena conventionally called “mental diseases” as
behaviors that disturb others (or sometimes the self), reject the image of “mental patients” as
helpless victims of patho-biological events outside their control, and refuse to participate in
coercive psychiatric practices as incompatible with the foundational moral ideals of free societies.
In short, I rejected the authority of the APA as a legitimating organization and of the DSMasa
legitimating document. I believe nothing less can undo the mischief wrought by the successive
editions of the “psychiatric bible.”

Settled by Political Power

But times have changed. Fifty years ago it made sense to assert that mental illnesses are not
diseases. It makes no sense to do so today. Professional debate about what counts as mental illness
has been replaced by political-judicial decree. The controversy about the nature of so-called
mental diseases/disorders has been settled by the holders of political power: They have decreed
that “mental illness is a disease like any other.” Political power and professional self-interest have
united in turning false beliefs into lying facts: “Mental illness can be accurately diagnosed,
successfully treated, just as physical illness” (President William Clinton, 1999). “Just as things go
wrong with the heart and kidneys and liver, so things go wrong with the brain” (Surgeon General
David Satcher, 1999).

The claim that “mental illnesses are diagnosable disorders of the brain” is not based on
scientific research; it is a deception and perhaps self-deception. My claim that mental illnesses are
fictitious illnesses is also not based on scientific research; it rests on the pathologist’s materialist-
scientific definition of illness as the structural or functional alteration of cells, tissues, and organs.
If we accept this definition of disease, then it follows that mental illness is a metaphor, and
asserting that view is stating an analytic truth not subject to empirical falsification.

For centuries the theocratic State exercised authority and used force in the name of God. The
Founders sought to protect the American people from the religious tyranny of the State. They did
not anticipate, and could not have anticipated, that one day medicine would become a religion and
that the alliance between medicine and the State would then threaten personal liberty and
responsibility exactly as they had been threatened by the alliance between church and State.

The Founders faced the challenge of separating the cure of souls by priests from the control of
people by politicians. Today the Therapeutic State exercises authority and uses force in the
name of health. We face the challenge of separating the consensual treatment of patients
by medical doctors from the coercive control of persons by agents of the State pretending to
be healers.

When psychiatry was in its infancy the belief that all human “dysfunctions” are manifestations
of brain diseases was a naive error. In its maturity the mistake was treated as a valid scient
ific theory and the justification for a powerful ideology and the powerful institutions based on it
. Today, in its senescence, psychiatry is deceit and self-deceit—coercion concealed as object
ive science (“medical diagnosis”) and benevolent help (“medical treatment”). As a result, para
phrasing Orwell, telling the truth becomes “a revolutionary act.”